Korean J Med.  2008 Jun;74(6):619-623.

The effect of low dose corticosteroid therapy on viral reactivation in patients with chronic hepatitis B virus infection

• Lee HI
• Gwak GY
• Park MK
• Suh HJ
• Lee JH
• Koh KC
• Paik SW
• Yoo BC

Abstract

BACKGROUND/AIMS: We investigated the effect of low dose corticosteroid therapy on HBV reactivation in patients with chronic HBV infection.
METHODS
From August 1998 to March 2007, the HBsAg-positive patients who received oral or intravenous corticosteroid therapy for more than 1 week at Samsung Medical Center were included in this retrospective study. We included those patients who received anticancer chemotherapy or organ transplantation, or concurrent antiviral therapy or other immunosuppressive agents. HBV reactivation was defined as a 10-fold increase in the HBV DNA levels compared with baseline.
RESULTS
A total of 16 patients were included. They were 45.4+/-16.7 years of age, and the male:female ratio was 14:2. Their combined diseases included bronchial asthma, allergic urticaria, allergic rhinitis, etc. The corticosteroid doses were converted to prednisolone equivalent doses and these varied from 2.5 mg to 50 mg per day. Eleven patients used less than 20 mg of prednisolone per day. The mean medication duration was 60.1 days (range: 7-364 days). Among the patients, only one patient showed HBV reactivation. This ankylosing spondylitis patient was a 31-year old man who took prednisolone 5 mg/day for 364 days. He displayed HBeAg-positivity before corticosteroid treatment. There was no aggravation of the levels of ALT, albumin, bilirubin, and PT between the pre-and post-medication in this patient.
CONCLUSIONS
The short term use of low dose corticosteroid is not likely to be related with HBV reactivation in those patients with chronic HBV infection, yet long term use may lead to viral reactivation. Further large scaled, prospective studies on this subject are needed.

Keyword

HBV DNA; Corticosteroid; HBeAg

MeSH Terms

Asthma
Bilirubin
DNA
Hepatitis B e Antigens
Hepatitis B, Chronic
Hepatitis, Chronic
Humans
Immunosuppressive Agents
Organ Transplantation
Prednisolone
Retrospective Studies
Rhinitis
Rhinitis, Allergic, Perennial
Spondylitis, Ankylosing
Transplants
Urticaria
Bilirubin
DNA
Hepatitis B e Antigens
Immunosuppressive Agents
Prednisolone